Background: Chronic kidney disease (CKD) is a chronic condition with poor outcomes and high costs, which disproportionately affects African Americans and other minorities. Collaboration between primary care physicians (PCPs) and nephrologists in the care of patients with CKD is widely advocated, but preferences regarding collaboration are unknown. With the aging of the United States population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of CKD is increasing. PCPs can engage in strategies proven effective in reducing the progression of kidney disease. The National Kidney Disease Foundation evidence-based guidelines, the Kidney Disease Outcomes Quality Inititiative (KDOQI), provide information for PCPs regarding delaying progress of and early referral for CKD. The focus of this capstone project was to assess and identify CKD management-related needs among PCPs and to educate regarding the KDOQI guidelines. Evidence Based Practice Framework: The Model for Change, developed by Rosswurm and Larrabee, was chosen to guide this evidence-based practice change. This capstone project had three objectives: (1) Innovation – to present evidence on the benefits of early referrals for CKD. To explore the natural progression of patients idenitified as having CKD and the characteristics for an effective early referral program. (2) Economic Analysis – implementing early referral strategies into the primary care practice would be used to assess and synthesize its cost effectiveness. (3) Collaboration – improve and strengthen dialogue between all stakeholders to improve the quality of care and reduce the incidence of end stage renal disease. Methods: Physicians’ recognition of CKD and their attitudes regarding the care of patients with CKD was explored. A two-part questionnaire was used to evaluate the current knowledge and understanding of CKD of five PCPs. Results: Providers varied in their views of CKD and their embracing of the guidelines. Some sought to implement only the pay-for-performance targets and other chose to not to implement any of it. Most expressed both problems and skepticism concerning blood pressure targets and acknowledged educational gaps. At the end of the project four of the PCPs showed increased knowledge of how to recognize CKD and when to refer to a nephrologist. Conclusions: PCPs play a critical role in the early evaluation and intervention of patients at risks, stressing the importance of the PCP as a first line defense and timely specialist referral in renal care. A rise, albeit small, in the referral rate was and encouraging result-indicating an increase in physicians’ knowledge base. Future study is needed to delineate pathways and underlying reasons for PCPs’ late referral patterns. Individually addressing PCPs’ lack of knowledge and concerns can decrease late referral.
